If still not at target add at long acting alpha blockere or low dose beta blocker nightly.

Step 6b: If baseline pulse is <84:

Add other subgroup of calcium channel blocker.(e.g., amlodipine if verapamil or diltiazem has been used)

Step 7: Consider referral to nephrologist or cardiologist if not at target BP.

a. Always include lifestyle modification.b. Move through successive steps until goal BP is reached.c. Use steps 1-4 if microalbuminuria / proteinura or GFR < 60 cc/min, regardless of BP.d. Special note: Use of beta blocker with a nondihydropyridine CCB (verapamil, diltiazem) should be avoided in the elderly and those with conduction abnormalities, instead choose hydralazine, clonidine, minoxidil or methyldopa.e. Special note: Clonidine should not be used with beta blockers because of the risk of severe bradycardia.